| NPI | 1295920288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 4193) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 3975) |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2014-09-16 |